Asthma exacerbations in the emergency department (ED): re-audit of PEFR recording, severity grading and primary care follow-up after the introduction of a staff education program

Abstract

Background: Asthma exacerbations account for half of respiratory presentations to the ED and hospitalise patients every 8 minutes in the UK. PEFR should be performed in all patients presenting with an asthma attack in order to assess severity. 1 in 8 patients discharged from ED will re-attend within 2 weeks and so primary care follow-up must be encouraged by ED staff (Emerman et al . Chest 1999). Objectives: To identify 1) rates of PEFR recording 2) accuracy of exacerbation severity grading 3) follow-up advice given by ED staff and 4) patient compliance with ED advice, before and after the introduction of an ED staff education program. Methods: Retrospective case note audit over a 3 month period (Sep-Nov) in 2013 and 2016. Patients contacted by telephone and completed a questionnaire regarding primary care follow-up. Results: Rates of PEFR recording were similar in 2013 and 2016 (63.0 v 63.7%). Less asthma exacerbations were graded incorrectly in 2016, however 92.1% of these were upgraded to acute severe and 7.9% to life-threatening. 69.0% of patients were told that they must receive primary care follow-up within 2 working days in 2016, compared to 65.0% in 2013, however patients are less likely to be able to attend an appointment within this time frame in 2016 (85.0 v 63.0%). Conclusion: PEFR recording remains unchanged following the introduction of an ED staff education program. Patients with severe attacks are being sent home. An education programme improves the follow up advice given by ED but patients are finding it more challenging to attend appointments in primary care.